Thursday, May 31, 2012

Based on new evidence on the effectiveness and harms of primary care-relevant interventions to prevent falls in community-dwelling older adults, the US Preventive Services Task Force (USPSTF) recommends physical therapy or exercise and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls.

USPSTF does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults aged 65 years or older, because it says the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, comorbid medical conditions, and patient values.

In extensive comments to USPSTF, APTA commended the task force for "its focus on physical therapy and the role that it plays in reducing the societal burden that falls present as the number one cause of injury among adults ages 65 and older." APTA also stated that it was "deeply concerned with the statement that 'the benefit is small' for multifactorial risk assessments in Recommendation 2." The association added, "… we feel that the approach to quantifying the effect of the risk assessment is misrepresentative given the unique considerations for falls prevention evaluation. A risk assessment may, in fact, not be appropriate for every member of the population, but a falls screening as outlined by the American Geriatrics Society and British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons is an important consideration to justify those individuals for which a multifactorial risk assessment is very impactful."

Comments

I agree with recommendation number two. A well qualified clinician should be allowed to determine whether a multifactorial risk assessment is needed and is ethically bound to perform that service only when needed. The APTA should focus on educating that physical therapists are the most qualified professionals to make those decisions.

Posted by Ted Yemm
on 5/31/2012 5:08 PM

The challenge for physical therapists is ID individuals at risk of falling prior to a fall. Once a fall has occured, the horse is out of the barn. I agree with the research needs and gaps recommendations regarding development of primary care tools to ID older adults at risk for falls. Recent studies appearing in PTJ and JGPT concur with this recommendation.